Not all Maalox are Equal

Not all Maalox products are interchangeable. Most parents think of antacids (for heartburn) when they hear the name Maalox, but Maalox Total Relief contains an anti-diarrheal agent. Recently, the FDA warned consumers to avoid Maalox mix-ups because the active ingredient in Maalox Total Relief, bismuth subsalicylate (related to aspirin), can cause serious side effects if it is taken by children and adults who are at risk for bleeding excessively. One such risk factor is having a history of gastrointestinal ulcers or bleeds. Another risk is taking anti-diabetic medicines, blood-thinning medicines (warfarin, aspirin), and nonsteroidal anti-inflammatory agents (ibuprofen, naproxen). Children and teenagers who are recovering from viral illnesses (chicken pox or flu-like illnesses) should also steer clear of aspirin-containing products to avoid Reye's Syndrome. Finally, patients allergic to aspirin should not take anything containing bismuth subsalicylate.

Novartis, the manufacturer, has agreed to rename Maalox Total Relief to remove the name Maalox and change the graphics to make it clearer that these are different products. You won't see these new packages until later in September. Until then, ask your pharmacist to make sure you're buying the right product for your child or yourself. Ask yourself: what is it that's bothering your child?

• Is it just gas? You can just get plain simethicone (Gas X, Mylicon, or generic equivalents) for gas relief.
• If your child has heartburn, acid indigestion, sour stomach, or upset stomach from these symptoms, but no gas, then Maalox Children's Relief will be appropriate.
  
• If your child is 6 and older and also needs gas relief, then choose Maalox Junior Plus.
  
• For children 12 and older with diarrhea and upset stomach and not recovering from a viral illness, try Maalox Total Relief. For heartburn, sour stomach, and acid indigestion relief without gas, try Maalox Regular Strength Chewable.
  
• Gas is also the problem? Then try either Maalox Advanced Maximum Strength Chewable Tablets or Maalox Advanced Regular Strength Liquid. Note that the Advanced Maximum Strength (as compared to Regular Strength) chewable tablets and the Advanced Regular Strength liquid both have simethicone, but they have different antacids. Here it becomes a preference of dosage form, as both will be effective against heartburn, acid indigestion, sour stomach, and upset stomach from these symptoms.
  

To identify which active ingredients each product contains, read the label under "Drug Facts." Below is a table that lists the active ingredients and the products that contain them. Please visit the manufacturer's web site for more detailed information. Report and side effects to the Medwatch program (that's how the FDA picked up that there is a potential danger when these products are confused).

	Active Ingredients	Indications
Maalox Children’s Junior Relief Chewable	Calcium carbonate	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms
Maalox Junior Plus	Calcium carbonate, simethicone	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms, bloating and pressure (gas)
Maalox Regular Strength Chewable Tablets	Calcium carbonate	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms
Maalox Advanced Maximum Strength Chewable Tablets	Calcium carbonate, simethicone	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms, bloating and pressure (gas)
Maalox Advanced Regular Strength Liquid	Aluminum hydroxide, magnesium hydroxide, simethicone	Acid indigestion, heartburn, sour stomach, upset stomach due to these symptoms, pressure and bloating (gas)
Maalox Total Relief	Bismuth subsalicylate	Diarrhea, upset stomach associated with nausea, heartburn, and gas from overeating